Mentalhealth

Games as an Assessment, Resilience and Monitoring tool.

Board games are quite a useful assessment and monitoring tool for mental illness and medication side effects in children. What is critical is that these games are accessible; it is necessary that those used not be so complicated that you will witness burn out by children simply due to an inability to understand the rules or play the game, they also need to be tactile with physical pieces to move around.

It is possible to ask questions of children, although few children have the vocabulary to articulate what they are experiencing well, that a therapist or psychiatrist knows they have understood what the child has attempted to convey.

Now here is the tricky thing about mental illness, an individual can seem perfectly fine for months even years while experiencing symptoms, until suddenly it is obvious that they aren’t ok anymore. The earliest signs of mental illness are not seen when we are at rest, they are seen when we are in action, while we navigate challenges, how we perceive and interact with others, how we respond to stress and stimulus around us. The stressful stages of our lives as we navigate high school and university is the most common time symptoms present, untreated mental illness undermines our ability to successfully navigate such challenges, it is when challenged that symptoms stop whispering and get loud.

Imagine for a moment that you are meeting a child for the first time, you have only 40 minutes to introduce yourself, learn how a child copes with defeat, success, challenge, and how short their fuse is. You don’t want to spend even half that time explaining how a game works, or just watching them kick a chair as they avoid answering direct questions or making eye contact, but rather majority of the time watching their interaction, how do you do it?

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You will see simple games in almost every office of counsellors or child psychologists, along with paper and pencils. They are simple to learn and most children are already familiar with them, those who are not learn quickly by following the lead of the therapist, if they don’t it is itself an observation of note.

By observing how quickly children decide their move, take their move, how well they plan their move, how they react to a loss or a win, can tell a lot about their coping skills or lack thereof. Do they rush and fumble or do they hesitate and consider? Can they sit still long enough to play the game, do they fidget and move, does the game retain their attention or do they repeatedly wander off when it is not their turn. The strength of their coping skills is only part of the story, although a big one.

Specialists are reluctant to diagnose mental illness in children, except as a last resort. Behavioural and developmental disorders such as ADHD and Autism often present in childhood, however the age of onset of mood and psychotic disorders is between 12 and 25. This is controversial as they can present earlier and misdiagnosis can occur, many individuals diagnosed with Autism or ADHD are later being diagnosed with Bipolar, Schizophrenia, Anxiety or Depression, while these conditions do also have high rates of comorbidity; Bipolar, Autism and ADHD in children is almost indistinguishable. Depending on diagnosis, treatment may change nothing, may make symptoms worse, could allow them to lead a normal life growing with their peers. This is complicated by the motivation for early intervention, the sooner therapies and treatment begins, the better long term outcome, IF they get it right. Misdiagnosis can delay treatment by an average of 10 years from onset of symptoms. I know for two individuals’ treatment was delayed by 18 and 20 years. For my eldest and youngest, treatment and therapies were delayed by 10 years for each due to lack of accurate diagnosis. It is important to take the time to get the diagnosis correct, a month to six months of work can determine the tone of the next decade or more.

Many behaviours which can be construed as symptoms are part of normal child development and growing up, where these behaviours reach the threshold requiring a diagnosis depends on their severity.

Often the early stages of mental illness can be addressed using CBT, teaching resilience and better coping skills. This isn’t to say that they don’t have an illness, these skills better equip them to manage the symptoms, even delay acute presentation of a disorder indefinitely. Particularly for children, unless severe, drug therapies are avoided for as long as possible due to children’s bodies being smaller and still growing rapidly, which can lead to long term consequences with psychoactive medications. Treating mental illness is not so simple as taking a pill and it goes away, there is no cure, even current treatments will not stop all symptoms, only allow individuals to better function despite the disorder.

Mental illness is treated with a combination of:

The truth is drug therapies and talk therapies are on Par for effectiveness, and even more effective if you use them both together.

One of the ways in which we can teach children better coping skills and resilience is giving them plenty of low risk opportunities to practice using them, this is where more advanced board games come into play. There is not the time in which to use advanced games in a clinical setting, time with specialists is limited, so it falls to the parents to work on changes at home, putting the advice into practice. It is also an opportunity to sit and observe how your children address challenges, monitor severity of symptoms, to report to their specialists.

There are several things children learn playing board games which are challenging and fun to play:

  1. How to Lose
    • The world hasn’t ended because I didn’t win, that was fun, let’s play again!
  2. How to Win
    • Humility
  3. Planning
  4. Self-control
  5. Resilience
  6. Attention
  7. Critical thinking
  8. How to work together
    • Cooperative games such as Escape: Curse of the Temple or Orc’s must die are unwinnable without teamwork.
  9. How to handle an attack and get back up.
    • Cthulhu Wars and Munchkin with their back-alley knife fight and backstab nature is fantastic for this lesson.

Observable symptoms:

It is possible to see far more while sitting and participating in a focused activity with individuals, more so than is possible while passing each other in hallways on the way to and from school, or while sharing a couch watching afternoon TV.

Our library of games is slowly growing and I am aware dwarfed by the scale of those of Gamerati’s readers.

What sets Board Games apart as suitable for this purpose?

  • Durable Miniatures
  • Thick Card Stock/Boards
  • Advanced mechanics
  • Accessibility, challenging and fun for all ages and abilities at the table, without intimidating.
  • Even if you lose, playing the game is fun.
  • Easy to learn, challenging to master.
  • Play duration which is challenging but not beyond the participants’ current attention

If playing with children with Developmental, Mood, or Behavioural Disorders, play a game which can withstand fidgets, or there will be tears.

Thankfully so far none of these titles have led to board flipping, as we have experienced with Monopoly, or screaming meltdowns as we encountered exploring the Tales of the Arabian Nights.

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My living room frequently resembled this until we determined, Monopoly is Evil.

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